History of mental health
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History of Mental Health. 1840’s-Dorthea Dix championed need for mental health institutions on a federal level By the 1920’s, State Hospitals were warehousing individuals who utilized them due to lack of social programs. Mental Health Reform. Early 1900’s, Mental Health Reform was started

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History of mental health
History of Mental Health

  • 1840’s-Dorthea Dix championed need for mental health institutions on a federal level

  • By the 1920’s, State Hospitals were warehousing individuals who utilized them due to lack of social programs

Mental health reform
Mental Health Reform

  • Early 1900’s, Mental Health Reform was started

  • Critical of State Hospitals run by the state governments

  • WWII-Focused attention on Mental Health Issues, due to 1 out of 4 draftees being rejected from duty because of mental health or neurological issues

  • Mental Health Act of 1946-established the National Institute of Mental Health that focused on modernizing treatment approaches to psychiatric care

Community health centers acts of 1963 1965
Community Health Centers Acts of 1963 & 1965

  • Act of 1963-Appropriated funds only for construction of Community Health Centers

  • Act of 1965-Staffing-Governmental proposals to institute federal programs for the aged and the poor

  • Focused on mental health prevention-a concept that was borrowed from the Public Health concept of prevention


  • Nixon Administration impounded funds for mental health programs

  • Reagan Administration collapsed all mental health funding to block grants

  • Between 1970-73, 14 state hospitals had closed, with Reagan promising to close all by 1980

  • Judicial decisions impacted treatment-increased civil rights of patients, while requiring the states to provide treatment

  • States provided narrow interpretation of Donaldson decision

  • Illusory legal decisions for the mentally ill-enhancing human rights and freedoms without any corresponding improvement in services to be provided

Revolving door
Revolving Door

  • High incidence of readmissions to the state hospitals and less money for treatment-medication management

  • Hospital related deaths

  • Mental health clients increase involvement to petty crime

  • By 2000, reforms change judicial policy and establish specialized courts to deal with mentally ill, non-violent offenders

Community mental health centers under siege
Community Mental Health Centers under siege

  • Chronically, mentally ill population that were discharged from state hospitals prove to be a burden for the service providers

  • CMHC’s receive cut in federal funding

  • Reagan provides block grants to states, but with a 21% cut

  • Reliance on government assistance programs

  • Reorganization-increase of case loads and target of chronic mentally ill treatment

Preventative committment
Preventative Committment

  • Out-patient programs have lack of follow thru by chronically mentally ill patients, but continue with increased hospitalization

  • Utilizes preventative commitment as a treatment modality to prevent decompensation of the chronically, mentally ill

  • Statue provides for mentally ill people who are unable to voluntarily comply with treatment and need treatment to prevent decompensation to be a danger to self, others, or a grave disability

Mental health service delivery
Mental Health Service Delivery

  • SAMSHA-Substance Abuse and Mental Health Services Administration-oversees block grants

  • Block grants administered since 1981

  • New Approaches to treatment delivery-Capitation Method

  • Predetermined amount of money to be provided per client that insist on a wide range of services to be delivered

Integrated mental health concept
Integrated Mental Health Concept

  • Categorical grants-Medicaid, Supplemental Security Income, Food Stamp Program. Local funding would be allocated to a common fund

  • Non-Profit Planning Committee-Would oversee planning and coordination, monitor performance, and evolve innovative programs

  • High-usage clients would be targeted for provision of less costly services in order to generate surpluses for less intensive programs

Parity for mental health care
Parity for Mental Health Care

  • 1996-Established parity form mental health treatment

  • Employers with more than 50 employees who offer any mental health coverage, must include mental health coverage comparable to physical health coverage

  • In 2000, survey found a resulting decrease in employee benefits

Substance abuse
Substance Abuse

  • High cost to society has provided much focus in social policy

  • Increase in block grants to fund programs

  • Public intolerance has escalated due to highway fatalities, HIV transmission between IV drug users, and Fetal Alcohol Syndrome and drug abuse affects among newborn infants

  • Drug-Free Schools Act of 1990-Provided $500 million for drug abuse prevention

  • Focus of treatment is mainly directed at intervention strategies and rehabilitation since there are not any major prevention initiatives